connecting career and mental health counseling: integrating … · 2017-01-03 · career, work, and...
TRANSCRIPT
NCDA 2009 St. Louis
Connecting Career and Mental
Health Counseling: Integrating
Theory and Practice
Janet G. Lenz, Ph.D.
Gary W. Peterson, Ph.D.
Robert C. Reardon, Ph.D.
Andrew R. Morrison, M.S.
Florida State University
Denise Saunders, Ph.D.
Private Practice
NCDA 2009 St. Louis
Career, Work, and Mental Health
Individuals seeking career counseling often present a complex array of issues, and thus it is difficult for counselors to separate career satisfaction and development from other mental health issues…
Zunker, V. (2008). Career, work, and mental health. Thousand Oaks, CA: Sage.
NCDA 2009 St. Louis
Career and Mental Health Issues are
Inextricable in Many Cases
Linda is depressed because she has not done well in high school and she has been very discouraged about her options after she graduates. Is this a career problem or a depression problem?
Alberto is worried about getting into medical school. He is not sleeping well at night and has become upset because his family and girlfriend are putting pressure on him. Is this a career problem or a relationship problem?
Fred returns home after work each day burdened with insoluble problems and the victim of a punitive supervisor. He feels sexually impotent with his wife. Is this a career problem or a problem of sexual dysfunction?
(Adapted from Krumboltz, 1993)
NCDA 2009 St. Louis
Research on Work and Mental Health
Unemployment, problematic work relationships, and stressful work conditions play significant roles in the development of physical and mental health problems and many times are indicators of the onset of mental illness.1
Work and family factors interact and influence job and marital satisfaction.2
Stressful life events, including those career-related, have been repeatedly identified to precede the onset of mental illness. Stressors can trigger underlying biological, physiological, and psychological illness.3
1. (Brenner, 1987; Frese & Mohr, 1987; Levi, 1984; Rose, Hurst, & Herd, 1979; Joelson & Wahlquist, 1987). 2. Metz, B. A. (1992). Toward an understanding of the reciprocal relationship between work and family. Dissertation
Abstracts International, 53(3-A), pp. 722. 3. Kleinman, A. (1988). Rethinking psychiatry: From cultural category to personal experience. New York: The Free Press.
NCDA 2009 St. Louis
Research Continued…
Clients who present for career concerns also feel the need to address education-related issues and egodystonic emotions related to work.4
Personality factors that affect mental health are also related to career choice, career progression, and work behaviors5 and that these personality traits are hereditary and remain stable over the course of the lifespan.6
4. Niles, S. G., Anderson, W. P., Jr., & Cover, S. (2000). Comparing intake concerns and goals with career counseling concerns. The Career Development Quarterly, 49, 135-145. 5. Eyeseck, H. J. (1990). Genetic and environmental contributions to individual differences: The three major
dimensions of personality. Journal of Personality, 58, 245-261. 6. Schultz, D. P., & Schultz, S. E. (2005). Theories of personality (8th ed.). Belmont, CA: Wadsworth Thomson..
NCDA 2009 St. Louis
V. Zunker, 2008
Holds two fundamental assumptions for conceptualizing and integrating clients’ career and personal development:
Holism; Whole-Person Approach
Biological, psychological, and social/cultural influences; Integrative Approach
NCDA 2009 St. Louis
“There is continuing acknowledgement that the
influences upon career choice and adjustment
throughout the life span are complex and
psychological, as well as social, political, and
economic.
Such a reality gives growing credence to viewing
career counseling as a therapeutic modality that
goes beyond dispensing and discussing information or
focusing on one’s work life as an isolated piece of
behavior.”
(Herr, 1989, p.13)
The incredible potential for facilitating change through Career Counseling
NCDA 2009 St. Louis
Program Implementation:
The Institution
Institutional history
Policies & procedures
Administrative structure
Space
Records
Tools & resources
NCDA 2009 St. Louis
Program Implementation:
The Personnel
Professional identity
Staff credentials
Supervision & training
Liability
Specializations
NCDA 2009 St. Louis
A. Level of
Client
Needs
C. Level of
Competencies
and Skills of
Counselors and
Staff B. Level of Career
Intervention
Complexity
Synthesis of three career services dimensions:
client needs, intervention complexity, staff competencies
Source: Sampson, J. P., Jr., Reardon, R. C., Peterson, G. W., & Lenz, J. G. (2004). Career counseling and services: A
cognitive information processing approach. Pacific Grove, CA: Brooks/Cole.
NCDA 2009 St. Louis
Case Example: FSU Career Center
Key elements--
mission
theory base
staff credentials & expertise
access to students in accredited counseling programs at Master’s & PhD level
nature of training provided
NCDA 2009 St. Louis
Mission
The mission of The Career Center is to:
Provide comprehensive career services
Train career service practitioners
Conduct life/career development research
Disseminate information about life/career services and issues to the university community, the nation, and the world.
NCDA 2009 St. Louis
Career theory connected to practice
Use of cognitive information processing (CIP) theory
Connection to other counseling theories and interventions (e.g., Beck)
Constructs from Holland’s theory that point to mental health issues, e.g., profile elevation, low vocational identity—”I am unsure of myself in many areas of my life”
CIP Theory
Pyramid of Information Processing
NCDA 2009 St. Louis
Executive Processing Domain
Metacognitions
Self-talk
Self-awareness
Control and monitoring
Screening
Readiness--
The capability of an individual to make appropriate career choices taking into account the complexity of family, social, economic, and organizational factors that influence career development
Source: Sampson, J. P., Jr., Reardon, R. C., Peterson, G. W., & Lenz, J. G. (2004). Career
counseling and services: A cognitive information processing approach. Pacific Grove, CA:
Brooks/Cole.
18
Levels of Service Delivery
Self-Help Services
Brief Staff-Assisted Services
Individual Case-Managed Services
CIP Readiness Model
Complexity (high)
Low readiness Moderate readiness
High degree of Moderate to low degree
support needed of support needed
(Individual Case- (Brief Staff-Assisted
Managed Services) Services)
Capability
(low) (high)
Moderate readiness High readiness
Moderate to low degree No support needed
of support needed (Self-Help Mode)
(Brief Staff-Assisted
Services)
(low)
NCDA 2009 St. Louis
Staff
PhDs on site for training, consultation, & supervision
Access to students enrolled in in counseling, counseling psychology, career counseling programs
Training materials
NCDA 2009 St. Louis
Assessment Issues
How are career assessments influenced by mental health status?
What are examples of assessments that bridge career and mental health domains?
How are these used in developing an individualized learning plan?
NCDA 2009 St. Louis
Career/Mental Health Assessments
Career Thoughts Inventory (CTI)
High career/low mental health
Problem Space (re-named Decision Space) Worksheet
MMPI
Low career/high mental health
What is the CTI?
Self-administered
Objectively scored
48-Item measure of dysfunctional thoughts in career choice
Theoretical Basis of the CTI
Cognitive Information Processing (CIP) Theory
Beck’s Cognitive Theory
Career Thoughts Defined
Outcomes of one’s thinking about
• assumptions,
• attitudes,
• behaviors,
• beliefs,
• feelings,
• plans, or
• strategies
related to career choice
The CTI in Needs Assessment
Identifying the specific nature of negative thoughts
Three CTI Construct Scales
Decision-making Confusion (DMC)
Commitment Anxiety (CA)
External Conflict (EC)
Specific career interventions can be related to specific construct scores
NCDA 2009 St. Louis
Mental health constructs directly correlated
with dysfunctional career thoughts
indecision
neuroticism
anxiety
angry hostility
depression
self-consciousness
impulsivity
vulnerability
Sampson, J. P., Jr., Peterson, G. W., Lenz, J. G., Reardon, R. C., & Saunders, D. E. (1996).
Career Thoughts Inventory: Professional manual. Odessa, FL: Psychological Assessment
Resources, Inc.
NCDA 2009 St. Louis
Using a Decision Space
Worksheet (DSW)
Cognitive mapping task
Helps clients reveal all thoughts, feelings, persons, circumstances associated with the career decision
Helps clients prioritize importance of contextual influences
NCDA 2009 St. Louis
Decision Space Worksheet
Page 1: list elements
Page 2: draw circles within a given circle in proportion to the importance of an element
NCDA 2009 St. Louis
Typical Issues Revealed
Financial
Family
Education
Interests
Self doubt
Employment
Quality of life
NCDA 2009 St. Louis
MMPI-2 in Career Counseling
Assesses personal and social adjustment
Measures clinical syndromes that may interfere with or block effective decision making
Used following screening measures such as CTI, DSW, and interview
NCDA 2009 St. Louis
Key MMPI-2 Scales
K (Correction)
Depression (D)
Psychopathic deviate (Pd)
Psychasthenia (Pt)
Schizophrenia (Sc)
Hypomania (Ma)
Social introversion (Si)
NCDA 2009 St. Louis
CASE STUDY: Ned
24 year-old computer programmer
Married, no children
Complains of boredom, monotony
Wants a more exciting career path
NCDA 2009 St. Louis
Screening Assessments: Ned
Intake Interview
Decision Space Worksheet (formerly called Problem Space Worksheet)
Career Thoughts Inventory
NCDA 2009 St. Louis
Ned’s List of Elements
NCDA 2009 St. Louis
Ned’s Problem Map
NCDA 2009 St. Louis
Ned’s CTI
Total Score T=61
Decision-Making Confusion (DMC) T=60
External Conflict (EC) T=60
Commitment Anxiety (CA) T=69
NCDA 2009 St. Louis
Ned’s ILP
NCDA 2009 St. Louis
Ned’s MMPI-2
NCDA 2009 St. Louis
Ned’s Counseling Outcomes
Identified areas of concern beyond the presenting career decision
Formulated counseling goals that integrated career and mental health issues
Involved helping services beyond the career center
Improved his quality of life related to career goals and peer and family relationships
NCDA 2009 St. Louis
Using CIP to integrate career and
mental health counseling
Provides a framework or model
Encourages client involvement
Identifies areas for exploration
Builds on existing knowledge
Enhances the counseling relationship
NCDA 2009 St. Louis
Using the CTI in practice
Allows for a holistic approach
Recognizes the complexities of the process
Raises client awareness of issues
Recognizes the impact of other life and mental health concerns
NCDA 2009 St. Louis
Summary
Clear support in the literature for integrating these areas
Important to consider organizational and programmatic issues
Implementation requires attention to staff resources, internal & external factors
Theory base can guide decisions about integrating career and mental health counseling
Assessment tools influence extent to which these factors might be considered
Unique issues to consider in private practice settings